Deep brain stimulation has emerged as a “last resort” therapy for patients with prolonged disorders of consciousness. The latter encompasses a range of conditions including minimal conscious state and persistent vegetative state. Functional neuroimaging studies have shown that minimal conscious state and persistent vegetative state have different patterns of residual brain function and may therefore respond differently to deep brain stimulation. The failure to distinguish between the two conditions in this context can give rise to false expectation, misunderstanding and ill-guided (...) treatment. As a halfway technology for prolonged disorders of consciousness, deep brain stimulation could also produce improvement in awareness that is in fact harm, and its impact may involve a wide range of public interests. This paper will discuss related ethical and legal issues with an emphasis on the distinction between minimal conscious state and persistent vegetative state in the application of deep brain stimulation. (shrink)

The “disability paradox” is the idea that for those who become severely disabled, their own quality of life assessment remains at or slightly below the QoL assessments of normal controls. This is a source of skepticism regarding third-person QoL judgments of the disabled. I argue here that this skepticism applies as well to those who are in the minimally conscious state. For rather simple means of sustaining an MCS patient’s life, the cost of being wrong that the patient would not (...) want further support is high. Pair this cost with the reason to be skeptical of third-person judgments, and my argument suggests not withholding food and water from MCS patients. (shrink)